Dimensions of clinical leadership among pre-registration nursing students: A cross-sectional study between two countries.

AIMS: To explore a) pre-registration students' self-perceptions of clinical leadership behaviours and b) differences in students' self-perceptions of leadership behaviours between two countries (UK and Israel). BACKGROUND: Effective leadership has been associated with high-quality and compassionate care provision in health and social care contexts. This has led to a common acceptance that teaching leadership in nursing education is essential if students are to develop competencies in this area. Worldwide, there is limited research on nursing students' perception of clinical leadership behaviours as well as on the development of leadership behaviours during the study years. DESIGN AND METHODS: A cross-sectional survey design was used among two convenience samples of UK and Israeli pre-registration nursing students. Closed questionnaires were uploaded in the format of a commercial internet survey provider (Qualtrics.com) and distributed through the virtual learning platforms in the two participating universities. In total 656 students were invited to participate and the response rates were 28.1 % (Israel) and 17.9 % (England). RESULTS: Overall, 140 students completed the questionnaires. Significant differences were found between the two sites in the leadership dimensions "Emotional Intelligence" and "Impact and Influence" (p < .05), with UK students scoring higher than Israeli students. Among the Israeli sample, significant differences were found in leadership dimensions according to years of study, with higher scores reported in the 3rd and 4th year students compared with the 1st and 2nd Year students in the referred dimensions (p < .05). CONCLUSIONS: Differences in students' clinical leadership perception exist between the two cohorts examined. Nurse educators should expand international research on this subject to identify possible antecedents in developing clinical leadership behaviours. At the same time, there is a need to continue efforts to enhance the development of clinical leadership behaviours during all study years through curriculum updating to prepare future nurses better to provide quality, safe and person-centered care.

Are we making the most of safe staffing research.

INTRODUCTION: The uptake of research evidence on staffing issues in nursing by nursing leadership, management and into organizational policies seems to vary across Europe. This study wants to assess this uptake of research evidence. DESIGN: Scoping survey. METHOD: The presidents of twelve country specific Sigma Chapters within the European Region answered written survey questions about work organisation, national staffing levels, national skill mix levels, staff characteristics, and education. RESULTS: Seven of the 12 chapters could not return complete data, reported that data was unavailable, there was no national policy or only guidance related to some settings. CONCLUSION: Enhancing the awareness of nursing research and of nursing leaders and managers regarding staffing level evidence is not enough. It seems necessary to encourage nurse leaders to lobby for staffing policies. CLINICAL RELEVANCE: Research evidence on staffing issues in nursing and how it benefits health care is available. In Europe this evidence should be used more to lobby for change in staffing policies.

Globalization: Migrant nurses' acculturation and their healthcare encounters as consumers of healthcare.

Globally, one of every eight nurses is a migrant, but few studies have focused on the healthcare experiences of migrant nurses (MNs) as consumers or recipients of healthcare. We address this gap by examining MNs and their acculturation, barriers to healthcare access, and perceptions of healthcare encounters as consumers. For this mixed-methods study, a convenience sample of MNs working in Europe and Israel was recruited. The quantitative component's methods included testing the reliability of scales contained within the questionnaire and using Hayes Process Model #4 to test for mediation. The qualitative component's methods included analyzing interviews with iterative inductive thematic analysis. Quantitative findings on MNs (n = 73) indicated that the association between acculturation and perception of the healthcare encounter, which MNs experienced as healthcare consumers, was mediated by barriers to healthcare access, even after adjusting for age and gender (p = 0.03). Qualitative interviews with MNs (n = 13) provided possible explanations for the quantitative findings. Even after working in the host country's healthcare system for several years, MNs reported difficulties with their healthcare encounters as healthcare consumers, not only due to their limited knowledge about the culture and healthcare resources but also due to the biased responses they received.

Clinical leadership in nursing students: A concept analysis.

OBJECTIVES: To undertake a concept analysis of clinical leadership in nursing students. DESIGN: Concept analysis. DATA SOURCES: A comprehensive search was conducted using the Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medline and PsychINFO using the following search terms: clinical leadership AND management AND preregistration OR pre-registration OR undergraduate AND nursing student* OR student nurse*. REVIEW METHODS: Nursing student clinical leadership was explored using the eight-step process of concept analysis proposed by Walker and Avant (2014). RESULTS: The defining attributes included effective interpersonal communication skills, contemporary clinical knowledge and being a role model to others. CONCLUSION: This concept analysis provides a definition of clinical leadership in nursing students. It will support understanding of the concept and how it is enacted in clinical placement settings.

Learning to lead: A scoping review of undergraduate nurse education.

AIM: To explore undergraduate student's preparation for leadership roles upon registration. BACKGROUND: Effective leadership is vital when promoting positive workplace cultures and high-quality care provision. However, newly registered nurses are not always well-prepared for leadership roles. EVALUATION: A scoping review of primary research published in English between 2009 and 2019 was undertaken. Data were analysed using an adapted version of Arksey and O'Malleys' (2005. International Journal of Social Research Methodology: Theory and Practice, 8, 19) framework. Nine papers met the review eligibility criteria. KEY ISSUES: Findings revealed three themes: leadership education content; positioning of leadership education within the nursing programme; and teaching and learning delivery. CONCLUSIONS: The review highlighted some agreement about the knowledge, skills and behaviours to be addressed in leadership education. What varied more was the pedagogical methods used to deliver this, the extent of its integration throughout the programme and the nature of collaborative academic-practice working to ensure good quality clinical supervision. IMPLICATIONS FOR NURSING MANAGEMENT: (a) Students must be exposed to positive leadership practices during clinical placements to facilitate theory-practice integration. (b) Bullying negatively impacts on students' self-efficacy whereas positive role modelling from registered nurses supports development of leadership competence. (c) Leadership theory and competence should be introduced early and revisited throughout the programme.

Migrants' Healthcare Experience: A Meta-Ethnography Review of the Literature.

PURPOSE: Worldwide, more than 214 million people have left their country of origin. This unprecedented mass migration impacts health care in host countries. This article explores and synthesizes literature on the healthcare experiences of migrants. DESIGN: A meta-ethnography study of qualitative studies was conducted. METHODS: Eight databases (Medline, the Cumulative Index to Nursing and Allied Health Literature [CINAHL], PsycINFO, Embase, Web of Science, Migration Observatory, National Health Service Scotland Knowledge Network, and Adaptive Spectrum and Signal Alignment [ASSIA]) were searched for relevant full-text articles in English, published between January 2006 and June 2016. Articles were screened against inclusion criteria for eligibility. Included articles were assessed for quality and analyzed using Noblit and Hare's seven-step meta-ethnography process. FINDINGS: Twenty-seven studies were included in the review. Five key contextualization dimensions were identified: personal factors, the healthcare system, accessing healthcare, the encounter, and the healthcare experience. These five areas all underlined the uniqueness of each individual migrant, emphasizing the need to treat a person rather than a population. Within a true person-centered approach, the individual's cultural background is fundamental to effective care. CONCLUSIONS: From the findings, a model has been designed using the five dimensions and grounded in a person-centered care approach. This may help healthcare providers to identify weak points, as well as to improve the organization and healthcare professionals' ability to provide person-centered care to migrant patients. CLINICAL RELEVANCE: The proposed model facilitates identification of points of weakness in the care of migrant patients. Employing a person-centered care approach may contribute to improve health outcomes for migrant patients.

Planned change or emergent change implementation approach and nurses' professional clinical autonomy.

BACKGROUND: Nurses' clinical autonomy is considered important for patients' outcome and influenced by the implementation approach of innovations. Emergent change approach with participation in the implementation process is thought to increase clinical autonomy. Planned change approach without this participation is thought not to increase clinical autonomy. Evidence of these effects on clinical autonomy is however limited. AIMS AND OBJECTIVES: To examine the changes in clinical autonomy and in personal norms and values for a planned change and emergent change implementation of an innovation, e.g. intensive insulin therapy. DESIGN: Prospective comparative study with two geographically separated nurses' teams on one intensive care unit (ICU), randomly assigned to the experimental conditions. METHODS: Data were collected from March 2008 to January 2009. Pre-existing differences in perception of team and innovation characteristics were excluded using instruments based on the innovation contingency model. The Nursing Activity Scale was used to measure clinical autonomy. The Personal Values and Norms instrument was used to assess orientation towards nursing activities and the Team Learning Processes instrument to assess learning as a team. RESULTS: Pre-implementation the measurements did not differ. Post-implementation, clinical autonomy was increased in the emergent change team and decreased in the planned change team. The Personal Values and Norms instrument showed in the emergent change team a decreased hierarchic score and increased developmental and rational scores. In the planned change team the hierarchical and group scores were increased. Learning as a team did not differ between the teams. CONCLUSIONS: In both teams there was a change in clinical autonomy and orientation towards nursing activities, in line with the experimental conditions. Emergent change implementation resulted in more clinical autonomy than planned change implementation. RELEVANCE TO CLINICAL PRACTICE: If an innovation requires the nurses to make their own clinical decisions, an emergent change implementation should help to establish this clinical autonomy.

Intensive insulin therapy implementation by means of planned versus emergent change approach.

BACKGROUND: Nurses' participation in decisions about new care procedures and protocols is potentially of benefit for patient outcomes. Whether nurses' participation in decisions is allowed in the implementation of innovations depends on the implementation approach used for the introduction. A planned change implementation approach does not allow it, an emergent change implementation approach does. AIM: To compare a planned change and an emergent change implementation approach to introduce an intensive insulin therapy to an intensive care unit (ICU). DESIGN: A prospective comparative study in an ICU in the Netherlands of two teams of nurses using either implementation approach. METHODS: Pre-introduction of the comparability of the two teams was assessed. The nurse compliance to the protocol was assessed as being nurses' behaviour according to the protocol and leading to acceptable glucose values. The effectiveness of the implementation was assessed by measuring the percentage of patients' glucose values within the target range, the occurrence of hypoglycaemic events and the time to glucose value normalization. Data were collected from December 2007 till January 2009. RESULTS: In the emergent change approach team there was better nurse compliance measurements than in the planned change approach team (83.5% vs 66,8% conform protocol), a better percentage of glucose values in the target range (53,5% vs 52.8%) and a shorter time to glucose value normalization. CONCLUSION: The implementation approach allowing nurse participation was associated with better nurse compliance and patient outcome measurements. The implementation approach did not conflict with introducing an evidence-based innovation. It was also associated with more effective adaptation of the protocol to changing circumstances. RELEVANCE FOR CLINICAL PRACTICE: When a new treatment requires adaptability to changing circumstances to be most effective, nurses' participation in decisions about the implementation of the treatment should be considered.

Psychometric properties of the Dutch version of the American Nursing Activity Scale in an intensive care unit.

AIM: To report the development and psychometric testing of the Dutch version of the Nursing Activity Scale in a Dutch intensive care unit nursing population. BACKGROUND: The Nursing Activity Scale developed by Schutzenhofer measures professional clinical autonomy, by inquiring about the nurses' intention to exercise their own clinical decisions. This autonomy is increasingly relevant due to the ongoing professionalization, nurses increasingly have to make their own clinical decisions. DESIGN: Instrument development. METHOD: The study was conducted from November 2007-February 2008 and consisted of the following steps: translation, expert panel content validation, reliability testing and further content validation, test-retest stability examination, additional internal consistency, and validity assessment. RESULTS: After the first reliability testing two items seen to describe a situation not applicable to intensive care unit nursing in the Netherlands were deleted from the questionnaire. In the test-retest stability assessment the intra class correlation coefficient was 0·76. The Cronbach's alpha of the final questionnaire was 0·82. The alphas of the subsamples with higher scores were significantly different from those with lower scores, supporting the validity of the weighing of the items. CONCLUSION.: The Dutch version of the nursing activity scale consists of 28 items and provides the opportunity to measure professional clinical autonomy for Dutch intensive care nurses using a well-established method.